MRI Tenography Shows No Clear Advantage for Equine Manica Flexoria Tears

Does Low-Field MRI Tenography Improve the Detection of Naturally Occurring Manica Flexoria Tears in Horses?

Anton D. Aßmann, José Suàrez Sànchez-Andrade, David Argüelles, Andrea S. Bischofberger

Background

Manica flexoria (MF) tears, a common pathology within the digital flexor tendon sheath (DFTS) in horses, are challenging to diagnose accurately using standard imaging methods like ultrasonography and radiography. High-field MRI provides detailed imaging but is less accessible. Low-field standing MRI, while more available, suffers from reduced spatial resolution. Gadolinium-enhanced MRI tenography (MRIt), used successfully in human and veterinary imaging, has been proposed to enhance diagnostic performance for MF tears.

Methods

This retrospective cross-sectional study involved ten horses with DFTS-related lameness confirmed by diagnostic blocks. All underwent ultrasonography, contrast radiography, low-field MRI, MRIt, and tenoscopy. Two blinded radiologists evaluated images for the presence and laterality of MF lesions. Tenoscopy served as the reference standard. Sensitivity and specificity were calculated for each modality, and statistical comparisons were made using McNemar’s test.

Results

Of the ten horses, seven had confirmed MF lesions via tenoscopy. MRIt and contrast radiography each detected 5 of 7 lesions (71% sensitivity, 100% specificity), while MRI and ultrasonography each detected 4 of 7 (57% sensitivity). MRI maintained 100% specificity, whereas ultrasonography showed only 33%. Differences in sensitivity and specificity between modalities were not statistically significant (p = 1). MRIt offered the unique benefit of lesion laterality determination.

Limitations

The primary limitation was the small sample size, which limited statistical power. Additional technical constraints included the use of short MRI protocols with thick slice acquisition (5 mm) and motion artifacts inherent to low-field MRI in standing horses. The results may not generalize to chronic or complex cases or to higher-resolution MRI systems.

Conclusions

Low-field MRIt did not significantly enhance the detection of naturally occurring MF tears compared to standard low-field MRI or contrast radiography. While MRIt and MRI provided improved specificity over ultrasonography, they did not outperform contrast tenography overall. MRIt may be beneficial in preoperative planning due to its ability to determine lesion laterality, but its routine clinical use requires further investigation with larger sample sizes.

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